The implantable cardioverter defibrillator (ICD) has emerged as an effective and life-saving biomedical device that delivers an electrical shock to terminate potentially lethal ventricular arrhythmias in patients at risk for sudden cardiac death. The survival benefits of the ICD may be diminished in a sizable number of patients who develop clinically significant symptoms of anxiety and depression. Women have been identified as an at risk group for psychological distress secondary to cardiac disease. Prior case studies suggest that cognitive-behavioral psychosocial interventions may be effective in reducing distress although there are no studies to date exploring the impact of a group-based psychosocial intervention for female ICD patients. This study is a two phase project in which to examine the patterns of adjustment that women display in response to their ICD and to then test the effectiveness of a psychosocial intervention for a female population of ICD recipients. The proposed project will examine the effect of the intervention on a variety of psychosocial (anxiety, depression, social support), physiological (cortisol, shock frequency), and broad health outcomes (generic and disease specific quality of life, arrhythmias). [unreadable] [unreadable] [unreadable]